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COLLATERAL DAMAGE: Drug addiction affects everyone

An estimated 10 percent of the babies that have to spend time in the Newborn Intensive Care Unit (NICU) at Duluth’s Essentia St. Mary’s Hospital each year are born with “drug dependency” issues and have to be weaned off of the drugs in their first days or weeks of life. Photo by Heather Ainsworth

Anyone who argues that drug addicts are only harming themselves need look only at the now familiar case of Vanessa Brigan to see the ripple effects caused by one person’s drug addiction.

The Carlton County courtroom was packed with more than 60 people when Brigan was sentenced to six years in prison for vehicular homicide last month. All of them were affected by the accident.

Brigan and passenger Jesse David McMillen were driving back from a methadone clinic in Brainerd on the morning of Oct. 1, 2012, when Brigan crossed the center line of the two-lane Highway 210 near Wright. Her car hit a Carlton County Highway Department truck, breaking the back axle and causing the truck to veer into oncoming traffic. Both Zachary M. Gamache, 25, and Mitchell D. Lingren, 29, died at the scene after being thrown from the truck. Brigan admitted to being high at the time of the accident, after injecting methadone directly into her bloodstream.

Gamache left behind a fiancee and her two sons, two loving parents and six brothers, in addition to numerous nieces and nephews, friends and extended family members. Lingren’s wife and two children were left without their much-loved husband and father, the steady rock of the family, a youth hockey coach to his young son’s team. His parents mourned the loss of a second son, and his sister another brother, just a month before her wedding. Both men were outstanding community members as well as dearly loved by friends and family alike, not to mention co-workers who were also profoundly affected by their deaths.

Not represented in that courtroom were Brigan’s loved ones. The three daughters, who now have to live with their grandmother in another state. Brigan’s mother and sister, Jessica Mandoli, who knew her before drugs as a happy, caring person, who could make her more serious sister laugh as well as being a person who would lend a hand to anyone without judging them.

Mandoli, who took care of Brigan’s girls for six weeks after the accident until her mother could make arrangements for them to come live with her, described what Brigan’s daughters had to deal with in the days and weeks that followed.

“I know there was a lot of denial and pain, not knowing what to expect and hearing negative things in the media,” she said, telling how one at least one of the girls, then ages 8, 9 and 11, had watched as the school news program actually reported on the accident.

Outside of the classroom, it was even worse.

“They were made fun of by other kids, who told them their mom was a murderer,” Mandoli said.

The grownups didn’t behave much better. Mandoli wouldn’t allow her sister’s kids or her own kids to go on Facebook, out of fear that they would see what people were posting.

“People were wishing she’d rot in hell, saying things like ‘I hope she dies,’ and complaining that there can be no justice,” she said. “The hurtful things people said on social media has been the most detrimental to my family. Yes, people have a right to their opinions, but I don’t think people think much about the other side, the fact that Vanessa means something to people, that she wasn’t always like that. Those who knew her before she was involved with drugs, we still have those memories and we still care about her.”

A tearful Mandoli didn’t make excuses for her sister, although she noteed that Vanessa is very remorseful and will likely struggle for the rest of her life with the knowledge of what she did. Mandoli is angry with her sister, and angry with the system.

At the time of the accident, it had been close to two years since Mandoli had had much contact with her sister.

“There was a point in time where I had to cut myself off because of her behavior,” Mandoli said in an interview in March of this year. “I didn’t want her or the people she associated with near me or my kids.”

Mandoli, who is trained as a nurse, had tried to intervene numerous times once she found out her sister was abusing prescription medication and, eventually, methadone, which was prescribed to her. (Methadone is a synthetic opioid used somewhat controversially in the treatment of heroin or other opioid addictions. It can also be abused and is highly addictive.)

She had talked to her sister, told her of different treatment options, listened to her sister’s promises to get treatment and watched as things keep getting worse.

She said more than one person contacted child protective services to make complaints about her sister, to try to get the county department to intervene, but were told they couldn’t do anything because it was hearsay. They needed evidence.

Calls to the police department also did no good — they couldn’t just go and search her house for drugs without justification, they said.

Although she had numerous driving violations, Brigan’s criminal record was minimal, so she wasn’t really a known threat. Just another addict making the rounds back and forth to Brainerd after the methadone clinic in Duluth shut down.

The accident caused by Brigan driving high that day is a worst-case scenario come true, but the truth is, Brigan had a prescription for methadone, and the trips she made back and forth to the methadone clinic in Brainerd were part of a treatment plan. She wasn’t scoring the drug off a dealer on the street, although she was using it “off-prescription” by injecting the drug to get high rather than drinking it to sate the need to use.

There are other people doing the same thing.

“Four to six hours a day going back and forth to get methadone treatments in Brainerd or St. Cloud is a lot of time in a car,” said Lisa Edmundson, a child protection investigator for Carlton County. “When you’re working with parents who spend that much time in a car for treatment, that doesn’t leave a lot of time to get other services in place, such as therapy, parenting classes or visitation with their kids.”

The arguments for and against methadone are complicated. Originally created to help wean heroin addicts off heroin, Carlton County Coroner and long-time doctor Ricard Puumala said methadone was created for the “worst of the worst,” as a replacement they could get from government-approved sources so they wouldn’t go out and commit crimes to get money for heroin. At some point, he said, the thinking became that people could be “weaned off” their addictions using methadone.

That’s an idea Puumala finds somewhat ridiculous.

Edmundson isn’t for or against methadone. She does think there are numerous flaws in the way methadone is distributed to treat addiction in reality, versus the ideal of combining methadone with counseling to help addicts overcome the traumas that often led to the addiction in the first place.

Edmundson and the County’s Children and Family Services supervisor, Brenda Carlson, will testify from experience that there is usually some kind of trauma in almost every addicted person’s past that they are trying to escape.

“I’d say 90 percent of the people we work with have had some kind of childhood or early adulthood trauma,” Edmundson said. “Abuse, a parent’s chemical dependency issues, sexual abuse … and they’re using [drugs] to cope.”

Carlson mentioned the death of a parent as another example.

“[Taking drugs] keeps a lot of folks that have been abused or suffered a traumatic event from hitting that deep emotion,” Carlson said. “It’s a way to cover, to self medicate, for intense emotion. It’s a psychological hurt and a physical hurt.”

Just because a parent is addicted to drugs, even heroin, doesn’t mean the Carlton County Children and Family Services workers will automatically get involved, either.

“We would only get involved if there is a maltreatment report, indicating how they’re not caring for or endangering their child,” Carlson said. “There could be thousands of people on methadone who are maintaining their lives. We’d only get involved if there is an issue with them not caring for their children or prenatal exposure (in the case of a pregnant woman).”

In the end, she explained, Health and Human Services has to be able to prove why a parent “isn’t fit” in a court of law and according to state statute. They need to know how the children are in danger, why they are at risk, how their health and safety needs aren’t being met.

“We have to make sure that the burden of proof is met before we can intervene,” Carlson said.

When they do get involved, both women explained, the goal is not to rip the child away from the family, even if the parents are addicted to drugs. There is a time frame they have to work within so a child doesn’t “languish,” but time and experience have also shown that taking a child away from his or her family is also not always healthy.

“If kids are removed, the goal is always to reunify the kids with the parents and help the parents be the best parents they can be,” Edmundson said.

“We want to keep the children safe, and give parents the resources and treatment to deal with the issues that got us involved in the first place,” Carlson said, noting that the reason the county gets involved with child protection cases has changed over the years.

“The reason kids are being referred to us is definitely more drug-related now,” she said.

Both praised the strong relationship the county has with local law enforcement agencies. Both sides work together in many cases where drug use is presenting a clear danger to children or others.

It’s the difference between a drug user hiding his or her use, locking the bathroom door and keeping all the paraphernalia locked away, versus the parent who leaves drugs, needles or bloody napkins lying around the home, or who is too stoned to effectively monitor their own child or children.

Local police will often call them to such a scene when children are present.

“I’ve worked in other counties where that weren’t that collaborative,” Edmundson said.

Edmundson said children know exactly what’s going on usually, but may not realize the dangers of the drug use.

“In my position, we interview the kids — if they’re verbal — to get an understanding of what is going on,” Edmundson said. “It’s interesting how descriptive they are. They can tell you step-by-step what it takes to shoot up. Where the spoon is. What they put on it. Where the needles are, they add a little of this, then they heat it, then they inject it here. And this is from a 4-year-old that I remember talking to. He told me where I could find stuff in the house, what color bin it’s in.

“Kids are exposed to a lot more and have a lot of that information … they’ve got little photographic memories that can give you so much detail. And to them it doesn’t seem like a huge deal. It’s what they see all the time. It’s what they’ve grown up with. It’s almost like they’re reporting on a movie … and they’re very accurate.”

She’s even had kids explain that a person can use a broken light bulb if they don’t have a glass pipe.

Edmundson said she’s even seen people take their children to the doctor for an injury and then take the child’s medicine.

“We’ve seen people steal from their friends, their grandparents,” Carlson said.

“I think there is an idea that stuff like this just happens in Duluth or Chicago,” Carlson said. “It happens here.”

The effects of drug addiction go beyond the addict and his or her family and friends.

It affects the community as a whole in obvious and more subtle ways. Increased medical and insurance costs. Assaults, medical emergencies, neighborhood problems and drug waste.

And who can calculate the loss in terms of the addicted? An addict is not only sick, he or she is likely not working to potential or otherwise contributing to society. The vast majority of addicts also end up involved in criminal activities to pay for the drugs to feed the addiction.

“They’ll do anything to try to get money. Sometimes it’s so blatant they will get caught, but they need that fix today so they don’t worry about the future.”

Berg said he feels bad for people addicted to drugs, but he feels worse for “the destruction they cause on their families and other people that have been victimized by them.”

“The effects of drug abuse touch everyone, even those lucky enough not to have family members struggling with drug or alcohol addiction,” he added.

Born into Drugs

When Dr. Christina Falgier started working at the Newborn Intensive Care Unit (NICU) at Duluth’s Essentia St. Mary’s Hospital, about 2 percent of babies in the intensive care unit spent the first days of their lives going through withdrawal from illicit drugs or prescription medication. Now that number is up to 10 percent or more, Falgier said, a five-fold increase in five years.

“It’s definitely a public health issue,” Falgier said, “affecting not only the mothers but their unborn babies and the family as a whole.”

There are times, the NICU doctor said, that as many as a third or more of the babies in the NICU unit are “drug dependent babies.”

“They don’t have addictive disease like the mother, they have dependent disease,” she explained. “Their bodies are dependent on the drugs, mostly opiates.”

The opiate class of drugs includes heroin, methadone, opium, morphine and many other prescription painkillers including OxyContin, Percocet, Vicodin, Hycodan, Codeine and more.

In recent years, both medical professionals and law enforcement have seen more people get addicted to opiates, first through an explosion of prescription medications taken to get high, then a rise in the abuse of methadone used to treat opiate addiction and finally, more recently, heroin. The reason the percentage of drug-dependent babies is often higher is because they have to stay in the NICU for longer periods of time than other babies. They have to be weaned off whatever drug (or combination of drugs) their tiny bodies were ingesting in the womb.

“The goal is to get them to be a normal baby,” Falgier said. “So they don’t need drugs. So they aren’t irritable and they are able to sleep properly, be calm.”

Most are not born premature, she said, explaining that premature babies born to drug-addicted mothers usually don’t show any neurological effects from the drugs.

“Maybe it’s because their brains aren’t developed as much,” she said.

Rather than using methadone to wean babies born to heroin-addicted mothers, Falgier said the hospital has moved to using more short-acting medications such as Suboxone or Subutex. Whereas doctors could only decrease the methadone dose on a weekly basis, they can do it every 24 to 48 hours with the other meds, she explained, therefore getting the baby off the drugs and out of the hospital that much sooner.

“We then encourage them to go to the NICU follow-up clinic,” she added, noting that society doesn’t do a good job of supporting the families of moms who may be seeking treatment for addiction.

“Of course we don’t want [addiction] to occur in the first place, but the reality is that it does,” she said. “And it’s a significant problem that affects the health of the mother, the family, the baby and any other children.